Provider Demographics
NPI:1508114422
Name:EMMONS, REBECCA S (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:S
Last Name:EMMONS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 MCMILLAN AVE
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4134
Mailing Address - Country:US
Mailing Address - Phone:251-580-8475
Mailing Address - Fax:251-937-0971
Practice Address - Street 1:2002 MCMILLAN AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4134
Practice Address - Country:US
Practice Address - Phone:251-580-8475
Practice Address - Fax:584-937-0971
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113223364S00000X, 364SP0200X, 364SW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner